Lower median household income (MHI) is an independent predictive factor for cancer-specific survival (CSS) and overall survival (OS) among patients with squamous cell carcinoma of the anus (SCCA), according to a study published in Cancer.

Although the outcomes for patients with SCCA has improved over time, these benefits have not been fully realized for the population as a whole. Researchers hypothesized that the socioeconomic status (SES) — defined by area-based MHI — may effect health outcomes for patients with SCCA.

For this study, authors accessed the Surveillance, Epidemiology, and End Results (SEER) database and assessed the outcomes of 9550 patients with SCCA diagnosed between 2004 and 2013. Patients were divided into quintiles according to their SES, and other measures such as demographic data (eg, age, sex, race, marital status), follow-up time, cause-specific survival, and OS were gathered.

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Multivariable analysis revealed that patients in areas of lower MHI had worse OS and CSS outcomes compared with patients in the highest income areas. In order of highest to lowest income, patient risk of dying increased from 16%, 19%, 31%, and 32% (mortality hazard ratio [HR], 1.16, 1.19, 1.31, 1.32), and risk of dying specifically from cancer increased from 22% to 34% at the lowest income quintile (CSS HR, 1.22, 1.27, 1.34, 1.32).

Other factors associated with worse CSS were black race, male sex, older age, an earlier year of diagnosis, higher tumor grade, and later American Joint Committee on Cancer stage of disease.

Income was not found to be associated with odds of initiating radiotherapy.

The authors concluded that “a better understanding of patients within their environmental context may help to inform policy interventions, promote awareness, increase resources and access to quality care for high-risk groups, and ultimately reduce observed disparities in cancer mortality.”


Lin D, Gold HT, Schreiber D, Leichman LP, Sherman SE, Becker DJ. Impact of socioeconomic status on survival for patients with anal cancer [published online March 12, 2018]. Cancer. doi: 10.1002/cncr.31186